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Clinical features and risk factors for pyogenic liver abscess caused by multidrug-resistant organisms: A
Qin Long1,2, Xiaoyu Zhao1,3, Chang Chen2
1Institute of Antibiotics, Huashan Hospital Fudan University, Shanghai, China.
Abstract:
The incidence rate of pyogenic liver abscess caused by multidrug-resistant bacteria has increased in recent years. This study aimed to identify the clinical characteristics and risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. We conducted a retrospective analysis of the clinical features, laboratory test results, and causes of pyogenic liver abscesses in 239 patients admitted to a tertiary hospital. Multivariable logistic regression was used to identify risk factors for multidrug resistance. Among patients with pyogenic liver abscesses, the rate of infection caused by multidrug-resistant organisms was observed to be 23.0% (55/239), with a polymicrobial infection rate of 14.6% (35/239). Additionally, 71 cases (29.7%) were associated with biliary tract disease. Patients with pyogenic liver abscesses caused by multidrug-resistant organisms had a significantly higher likelihood of polymicrobial infection and increased mortality (7/44 [15.9%] vs. 3/131 [2.3%]; p = .003). The Charlson Comorbidity Index (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.06-1.68), hospitalization (aOR: 10.34, 95% CI: 1.86-60.3) or an invasive procedure (aOR: 9.62; 95% CI: 1.66-71.7) within the past 6 months, and gas in the liver on imaging (aOR: 26.0; 95% CI: 3.29-261.3) were independent risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. A nomogram was constructed based on the risk factors identified. The nomogram showed high diagnostic accuracy (specificity, 0.878; sensitivity 0.940). Multidrug-resistant organisms causing pyogenic liver abscesses have specific characteristics. Early identification of patients at high risk of infection with multidrug-resistant organisms could help improve their management and enable personalized treatment.
Insights
Multidrug-resistant bacteria are increasingly causing pyogenic liver abscesses. Risk factors include comorbidities, recent procedures, and gas on imaging, aiding early identification and personalized treatment for better outcomes.
Area of Science:
- Infectious Diseases
- Hepatology
- Microbiology
Background:
- Pyogenic liver abscess (PLA) incidence is rising, particularly due to multidrug-resistant organisms (MDROs).
- Understanding clinical characteristics and risk factors for MDRO-PLA is crucial for effective management.
Purpose of the Study:
- To identify clinical features and risk factors associated with pyogenic liver abscesses caused by multidrug-resistant bacteria.
- To develop a predictive tool for early identification of high-risk patients.
Main Methods:
- Retrospective analysis of 239 PLA patients.
- Multivariable logistic regression to identify risk factors for MDRO infection.
- Development and validation of a predictive nomogram.
Main Results:
- MDROs accounted for 23.0% of PLA cases, with a 14.6% polymicrobial infection rate.
- MDRO-PLA was associated with higher mortality (15.9% vs. 2.3%) and polymicrobial infections.
- Independent risk factors for MDRO-PLA included Charlson Comorbidity Index, recent hospitalization/procedures, and gas on imaging.
- The developed nomogram demonstrated high diagnostic accuracy (sensitivity 0.940, specificity 0.878).
Conclusions:
- MDROs causing PLA exhibit distinct clinical characteristics and risk factors.
- Early identification of high-risk patients using the nomogram can improve PLA management and personalize treatment strategies.
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